Provider Demographics
NPI:1114692829
Name:SANTA TERESA PHARMACY II LLC
Entity Type:Organization
Organization Name:SANTA TERESA PHARMACY II LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAJ
Authorized Official - Middle Name:RAKESH
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-589-1646
Mailing Address - Street 1:PO BOX 7649
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS
Mailing Address - State:AZ
Mailing Address - Zip Code:85349-6815
Mailing Address - Country:US
Mailing Address - Phone:928-328-1000
Mailing Address - Fax:928-328-1001
Practice Address - Street 1:1896 E BABBIT LN
Practice Address - Street 2:
Practice Address - City:SAN LUIS
Practice Address - State:AZ
Practice Address - Zip Code:85336-7820
Practice Address - Country:US
Practice Address - Phone:928-328-1000
Practice Address - Fax:928-328-1001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy